Final Hours Flashcards
1
Q
Common Clinical Changes in the final hours?
A
- mobility
- GI
- GU
- respiratory
- CVS
- neurologic
2
Q
Mobility: changes and care
A
- decrease in mobility
- PPS- bedrest, maximum assistance
⭕Turn at least 2x per shift
⭕Incident pain meds
⭕Braden scale
3
Q
GI: changes and care
A
- dysphagia
- ⬇ intake to no intake
- ⬇ appetite
❌Do not force fluid❌
⭕Oral care
4
Q
GU: changes and care
A
- ⬇ output
- incontinence
- retention
❗Foley catheter- should be for patients comfort not for nurse
⭕✔skin breakdown
⭕Change briefs c turn
5
Q
Respiratory: changes
A
- “death rattle”- noisy, moist breathing
- congestion d/t inability to clear up mucus
- ⬆ secretions
- changes in breathing patterns: cheyne-stokes, rapid shallow, agonal
6
Q
Respiratory changes: Breathing patterns
A
- cheyne-stokes- periods of apnea
- rapid shallow- when close to dying
- agonal
7
Q
Respiratory congestion: contributing factors
A
- infection, inflammation
- pulmonary embolus
- CHF, pulmonary edema
- dysphagia
- Fluid overload?
8
Q
Respiratory congestion: Intervention
A
- Raise HOB -45 degrees
- No suctioning
- pharmacologic intervention: scopolamine, glycopyrolate, atropine
9
Q
Respiratory congestion: Pharmacologic intervention
A
1) Scopolamine - (preferred)
2) Glycopyrolate
3) Atropine
10
Q
Scopolamine
A
- dilates bronchial smooth muscle
- ⬇ GI secretions
- ⬇ peristalsis
- SEDATION
- Urinary retention
11
Q
Atropine
A
- tachycardia
- dry, flushed skin
12
Q
Glycopyrolate
A
- less sedating
- longer duration
- not as effective as scopolamine
13
Q
CVS Changes
A
- ⬇BP
- rapid weak pulse
- arrhythmia
- cool, mottled skin starting from extremities
14
Q
Neurologic changes
A
- ⬇LOC
- Confusion
- Delirium
- “primitive” reflexes
15
Q
Primitive reflexes
A
- Rooting
- Grasping
- Sucking
16
Q
Medication changes
A
- d/c meds: anti-htn, thyroid meds, hormone replacement, supplements
- d/c non-critical meds
- switch to another route
- short acting analgesic for painful procedures
17
Q
Early signs of death
A
- absent pulse
- absent respiration
- dilated and fixed pupils
- absent response to stimulus
18
Q
Later sign of death
A
- early signs +
- cool, mottling skin
- rigor mortis
- livor mortis
19
Q
Care after death
A
- support family
- dentures in if possible
- remove most tubings (❌ central lines)
- remove jewelry and give to family
- align in natural position
- clean unsightly drainage
- encourage family to stay as long as they wish
- shroud
- morgue
- funeral home pick up body
20
Q
To avoid inappropriate interventions..
A
- HCD
- letter from physician.. When want to die at home
- ❌ call ambulance
- ❌ call 911
